What to do when the doc won’t refer to hospice, by Monica Williams-Murphy, MD

Friday, 18 Apr 2014 06:11

About Dr. Monica Williams-Murphy (120 Posts)

Dr. Monica Williams-Murphy is a Board Certified Emergency Medicine Physician, who practices in one of the largest emergency departments in the United States at Huntsville Hospital. Through her writing and speaking, she is devoted to transforming the end of life into a time of peace, closure and healing. Media Page


One of the most common questions I receive is: “What should be done when the patient and family are ready for hospice (even asking for hospice), but the physician will not make the referral?”

My advice is simple… Fire the doctor.

If the whole quality of your end-of-life depends on appropriate and timely hospice referral, then why would you let a physician stand in the way of creating a good and peaceful dying experience?

Okay now pick your jaw up off the floor…

I can already hear your resistance to the idea.

Now, you might say, “But, Dr. X is my friend. You can’t fire a doctor who is your friend, right?”


The resolution could be as simple as saying, “Dr. X, you’ve been our doctor for 25 years. We are so grateful for the care and concern that you have given us. However, at this point, we really need hospice care and if you’re unable to refer us, then we will have to find someone who can. Thanks for your understanding.”

Maybe you are simply afraid of firing a doctor because it certainly sounds like a big deal.

Well, here’s an orienting question to help you: Are you more afraid of firing your doctor or having a bad and regrettable dying experience?

The only arguable roadblock to firing a hospice-resistant doctor and finding another, is that it may be hard to actually find another doctor-especially in the present insurance milieu.

But don’t worry, I have a backup plan for you.

You see, emergency departments are considered the safety-net health service for the nation. I can almost guarantee you that your local friendly emergency physician would be more than happy to assess you and make a hospice referral- in fact, making early palliative care and hospice referrals is part of our mission statement for the future (See below**).

So repeat after me, without fear:  “If my doctor cannot or will not make a hospice referral, then I will fire him or her and find another who will. The whole quality of my end-of-life experience depends on it.”


**Quote from the American College of Emergency Physician’s “Choosing Wisely”Campaign:

“Don’t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit. Palliative care is medical care that provides comfort and relief of symptoms for patients who have chronic and/or incurable diseases. Hospice care is palliative care for those patients in the final few months of life. Emergency physicians should engage patients who present to the emergency department with chronic or terminal illnesses, and their families, in conversations about palliative care and hospice services. Early referral from the emergency department to hospice and palliative care services can benefit select patients resulting in both improved quality and quantity of life.”


Our Book: It's OK to Die

"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones.
Learn More..

5 thoughts on “What to do when the doc won’t refer to hospice, by Monica Williams-Murphy, MD

  1. Pingback: What to do when the doc won’t refer to hospice, by Monica Williams-Murphy, MD | It’s OK to Die | All Things Palliative - Article Feed

  2. Rea

    It’s not easy, but it works. Early referral can certainly benefit the hospice patient & family! We hospice workers beg for that early referral! Usually improves quality of life, and often the hospice patient lives longer, too. Wow! Quite some benefit, wouldn’t you say??!!

    Chief Disruption Officer — in the most constructive way. Dr. Murphy’s got your back!

    The future belongs to those who challenge the present.

  3. Fran Riggins

    I never tire of reading Dr. Williams-Murphy’s no-nonsense approach to life and death in the ER. She is such a strong advocate for patients, it is amazing! May God continue to bless her and the patients who are fortunate to end up in her care!

  4. Tom Lorenz

    Awesome advice Monica. I whole-heartedly agree. I think you hit on the major fear, the fear of being left dangling with no medical professional to attend to the needs of the dying person. The suggestion to visit your local ED and talk to a doc is brilliant. Thanks for the ED mission statement. I think many of us have had the same fear, not knowing what to do when we fire the doc. When Abe Lincoln had the exact same kind of problem with his generals, HE FIRED THEM!! The time for our doctors to be patient-centered rather than practice-centered is now! Thanks for all you do for this great cause.

  5. Sherry Hall

    Thank you for the wonderful advice, and for the ER mission statement. It is amazing that even then some physicians find it so hard to let go that they will come to the hospital ER and talk you out of hospice! Yes, sadly, that really happened.


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